Medicare Reimbursement for CPT 15040

This page covers the Medicare Physician Fee Schedule (PFS) allowed amount for procedure code 15040, a CPT-coded surgical/medical service. Because CPT descriptors are proprietary to the AMA, we refer to it generically here rather than reproducing the official description. The figures shown reflect the national PFS rate as well as locality-adjusted amounts, broken out by non-facility and facility settings.

Medicare allowed amount (2026)

Locality	Non-facility	Facility
National (unadjusted)	$273.55	$113.90
ALASKA* (AK)	$313.14	$143.11
ALABAMA (AL)	$243.58	$103.88
ARKANSAS (AR)	$239.80	$102.65
ARIZONA (AZ)	$265.66	$110.95
SAN FRANCISCO-OAKLAND-BERKELEY (SAN FRANCISCO/SAN MATEO/ALAMEDA/CONTRA COSTA CNTY) (CA)	$352.69	$127.58
SAN JOSE-SUNNYVALE-SANTA CLARA (SANTA CLARA CNTY) (CA)	$359.58	$129.35
OXNARD-THOUSAND OAKS-VENTURA (CA)	$306.21	$117.50
LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) (CA)	$307.78	$118.90
NAPA (CA)	$333.65	$123.23
SAN FRANCISCO-OAKLAND-BERKELEY (MARIN CNTY) (CA)	$353.12	$128.01
VALLEJO (CA)	$333.03	$122.61
BAKERSFIELD (CA)	$288.62	$113.63
CHICO (CA)	$287.56	$112.58
FRESNO (CA)	$287.56	$112.58
HANFORD-CORCORAN (CA)	$287.56	$112.58
MADERA (CA)	$287.56	$112.58
MERCED (CA)	$287.56	$112.58
MODESTO (CA)	$287.56	$112.58
REDDING (CA)	$287.56	$112.58
RIVERSIDE-SAN BERNARDINO-ONTARIO (CA)	$291.65	$116.67
SACRAMENTO-ROSEVILLE-FOLSOM (CA)	$301.91	$116.23
SALINAS (CA)	$300.80	$115.76
SAN JOSE-SUNNYVALE-SANTA CLARA (SAN BENITO CNTY) (CA)	$361.34	$131.12
SANTA CRUZ-WATSONVILLE (CA)	$311.11	$117.13
SANTA ROSA-PETALUMA (CA)	$314.24	$118.19
STOCKTON (CA)	$287.56	$112.58
VISALIA (CA)	$287.56	$112.58
YUBA CITY (CA)	$287.56	$112.58
EL CENTRO (CA)	$287.62	$112.64
SAN DIEGO-CHULA VISTA-CARLSBAD (CA)	$308.06	$117.11
SAN LUIS OBISPO-PASO ROBLES (CA)	$295.98	$114.13
SANTA MARIA-SANTA BARBARA (CA)	$301.98	$115.82
REST OF CALIFORNIA (CA)	$287.56	$112.58
COLORADO (CO)	$284.08	$114.21
CONNECTICUT (CT)	$292.59	$120.64
DC + MD/VA SUBURBS (DC)	$313.34	$125.27
DELAWARE (DE)	$270.25	$112.51
FORT LAUDERDALE (FL)	$286.35	$124.62
MIAMI (FL)	$300.98	$134.78
REST OF FLORIDA (FL)	$271.33	$118.69
ATLANTA (GA)	$279.43	$117.22
REST OF GEORGIA (GA)	$254.85	$112.44
HAWAII, GUAM (HI)	$295.02	$113.50
IOWA (IA)	$249.26	$103.18
IDAHO (ID)	$251.21	$104.32
EAST ST. LOUIS (IL)	$270.77	$123.88
SUBURBAN CHICAGO (IL)	$289.09	$125.13
CHICAGO (IL)	$291.42	$130.97
REST OF ILLINOIS (IL)	$263.67	$117.90
INDIANA (IN)	$252.74	$104.74
KANSAS (KS)	$248.47	$104.14
KENTUCKY (KY)	$250.75	$108.81
NEW ORLEANS (LA)	$263.73	$113.49
REST OF LOUISIANA (LA)	$250.51	$109.22
METROPOLITAN BOSTON (MA)	$312.80	$122.17
REST OF MASSACHUSETTS (MA)	$282.39	$114.27
BALTIMORE/SURR. CNTYS (MD)	$291.89	$120.58
REST OF MARYLAND (MD)	$275.51	$113.94
SOUTHERN MAINE (ME)	$267.11	$108.89
REST OF MAINE (ME)	$253.10	$106.21
DETROIT (MI)	$275.41	$121.34
REST OF MICHIGAN (MI)	$258.16	$112.40
MINNESOTA (MN)	$270.29	$106.01
METROPOLITAN ST. LOUIS (MO)	$264.18	$112.19
METROPOLITAN KANSAS CITY (MO)	$261.32	$111.40
REST OF MISSOURI (MO)	$246.21	$108.59
MISSISSIPPI (MS)	$243.03	$105.57
MONTANA** (MT)	$273.53	$113.87
NORTH CAROLINA (NC)	$255.86	$106.90
NORTH DAKOTA** (ND)	$266.01	$106.36
NEBRASKA (NE)	$250.59	$103.22
NEW HAMPSHIRE (NH)	$279.99	$113.79
NORTHERN NJ (NJ)	$309.84	$124.64
REST OF NEW JERSEY (NJ)	$295.40	$121.05
NEW MEXICO (NM)	$259.86	$113.45
NEVADA** (NV)	$271.63	$111.81
MANHATTAN (NY)	$316.87	$131.35
NYC SUBURBS/LONG ISLAND (NY)	$325.59	$135.76
POUGHKPSIE/N NYC SUBURBS (NY)	$297.74	$122.92
QUEENS (NY)	$318.95	$130.24
REST OF NEW YORK (NY)	$260.00	$108.32
OHIO (OH)	$256.63	$110.86
OKLAHOMA (OK)	$249.78	$107.21
PORTLAND (OR)	$293.07	$115.69
REST OF OREGON (OR)	$269.00	$109.98
METROPOLITAN PHILADELPHIA (PA)	$285.20	$119.00
REST OF PENNSYLVANIA (PA)	$256.81	$110.24
PUERTO RICO (PR)	$275.52	$114.10
RHODE ISLAND (RI)	$279.88	$114.95
SOUTH CAROLINA (SC)	$256.77	$109.25
SOUTH DAKOTA** (SD)	$265.13	$105.47
TENNESSEE (TN)	$249.87	$104.74
BRAZORIA (TX)	$269.52	$111.30
DALLAS (TX)	$271.55	$112.54
GALVESTON (TX)	$270.52	$111.98
HOUSTON (TX)	$277.48	$118.94
BEAUMONT (TX)	$255.04	$109.75
FORT WORTH (TX)	$269.76	$112.34
AUSTIN (TX)	$283.59	$114.67
REST OF TEXAS (TX)	$262.34	$110.83
UTAH (UT)	$260.51	$110.44
VIRGINIA (VA)	$266.49	$109.55
VIRGIN ISLANDS (VI)	$275.52	$114.10
VERMONT (VT)	$265.33	$107.27
SEATTLE (KING CNTY) (WA)	$318.92	$123.02
REST OF WASHINGTON (WA)	$281.74	$113.62
WISCONSIN (WI)	$256.55	$103.60
WEST VIRGINIA (WV)	$253.38	$114.64
WYOMING** (WY)	$270.25	$110.60

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Maximum units per day (MUE)

Medicare’s Medically Unlikely Edit caps this code at 1 unit per patient per day — Date of Service Edit: Policy. Units above the MUE are denied; some MUEs can be exceeded only with appropriate documentation and modifiers where policy allows.

How the amount is calculated

Medicare bases payment on three Relative Value Units (RVUs) assigned to the code: physician work, practice expense, and malpractice risk. Each RVU component is adjusted by Geographic Practice Cost Indices (GPCIs) specific to the provider's locality, reflecting regional cost differences. The adjusted RVUs are summed and multiplied by the annual conversion factor (a dollar-per-RVU rate set by CMS) to produce the allowed amount. Non-facility rates (e.g., office settings) typically use higher practice-expense RVUs than facility rates (e.g., hospital settings), since the practice bears fewer overhead costs when the service is furnished in a facility.

RVUs — work 1.95, practice expense 5.86 (non-facility) / 1.08 (facility), malpractice 0.38 — × the locality GPCIs × the 2026 conversion factor of $33.40.

Good to know

All amounts are estimates based on the national PFS formula; actual payment depends on your specific locality GPCIs.
Medicare typically pays 80% of the allowed amount after the patient meets their deductible; the patient or secondary insurance is responsible for the remainder.
Modifiers, multiple-procedure reductions, sequestration, and annual budget-neutrality adjustments can all change the final paid amount.
Always confirm current-year rates and locality-specific amounts with your Medicare Administrative Contractor (MAC) before billing or appealing a denial.

Frequently asked

Why does the facility rate differ from the non-facility rate for this code?

The facility rate uses lower practice-expense RVUs because Medicare assumes the facility (e.g., hospital) — not the billing practice — incurs most of the overhead costs like equipment, supplies, and staff time.

Does this amount represent what my practice will actually receive?

No — it's an estimate based on the national conversion factor and standard RVUs. Your locality's GPCIs, any applicable modifiers, and sequestration adjustments will change the final allowed and paid amounts.

Can this code's reimbursement change mid-year?

CMS typically updates the conversion factor and RVUs annually, but mid-year corrections, budget-neutrality adjustments, or legislative changes can occasionally affect rates.

Why isn't the official CPT description shown here?

CPT codes and descriptors are copyrighted by the American Medical Association, so we reference the code generically rather than reproducing the licensed language.

More free billing tools: all Medicare fees · fee calculator · denial code decoder

Estimated Medicare Physician Fee Schedule amount. Medicare generally pays 80% after the deductible; actual amounts vary by locality, modifiers, sequestration, and annual updates. Verify with your MAC.